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Patwardhan V, Gil GF, Arrieta A, Cagney J, DeGraw E, Herbert ME, Khalil M, Mullany EC, O'Connell EM, Spencer CN, Stein C, Valikhanova A, Gakidou E, Flor LS. Differences across the lifespan between females and males in the top 20 causes of disease burden globally: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Public Health 2024; 9:e282-e294. [PMID: 38702093 PMCID: PMC11080072 DOI: 10.1016/s2468-2667(24)00053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Sex and gender shape health. There is a growing body of evidence focused on comprehensively and systematically examining the magnitude, persistence, and nature of differences in health between females and males. Here, we aimed to quantify differences in the leading causes of disease burden between females and males across ages and geographies. METHODS We used the Global Burden of Disease Study 2021 to compare disability-adjusted life-year (DALY) rates for females and males for the 20 leading causes of disease burden for individuals older than 10 years at the global level and across seven world regions, between 1990 and 2021. We present absolute and relative differences in the cause-specific DALY rates between females and males. FINDINGS Globally, females had a higher burden of morbidity-driven conditions with the largest differences in DALYs for low back pain (with 478·5 [95% uncertainty interval 346·3-632·8] more DALYs per 100 000 individuals among females than males), depressive disorders (348·3 [241·3-471·0]), and headache disorders (332·9 [48·3-731·9]), whereas males had higher DALY rates for mortality-driven conditions with the largest differences in DALYs for COVID-19 (with 1767·8 [1581·1-1943·5] more DALYs per 100 000 among males than females), road injuries (1012·2 [934·1-1092·9]), and ischaemic heart disease (1611·8 [1405·0-1856·3]). The differences between sexes became larger over age and remained consistent over time for all conditions except HIV/AIDS. The largest difference in HIV/AIDS was observed among those aged 25-49 years in sub-Saharan Africa with 1724·8 (918·8-2613·7) more DALYs per 100 000 among females than males. INTERPRETATION The notable health differences between females and males point to an urgent need for policies to be based on sex-specific and age-specific data. It is also important to continue promoting gender-sensitive research, and ultimately, implement interventions that not only reduce the burden of disease but also achieve greater health equity. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Vedavati Patwardhan
- Center on Gender Equity and Health, University of California, San Diego, CA, USA
| | - Gabriela F Gil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alejandra Arrieta
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jack Cagney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin DeGraw
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly E Herbert
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mariam Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Cory N Spencer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caroline Stein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Aiganym Valikhanova
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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Tana C, Raffaelli B, Souza MNP, de la Torre ER, Massi DG, Kisani N, García-Azorín D, Waliszewska-Prosół M. Health equity, care access and quality in headache - part 1. J Headache Pain 2024; 25:12. [PMID: 38281917 PMCID: PMC10823691 DOI: 10.1186/s10194-024-01712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Current definitions of migraine that are based mainly on clinical characteristics do not account for other patient's features such as those related to an impaired quality of life, due to loss of social life and productivity, and the differences related to the geographical distribution of the disease and cultural misconceptions which tend to underestimate migraine as a psychosocial rather than neurobiological disorder.Global differences definition, care access, and health equity for headache disorders, especially migraine are reported in this paper from a collaborative group of the editorial board members of the Journal of Headache and Pain. Other components that affect patients with migraine, in addition to the impact promoted by the migraine symptoms such as stigma and social determinants, are also reported.
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Affiliation(s)
- Claudio Tana
- Center of Excellence on Headache and Geriatrics Clinic, SS Annunziata Hospital of Chieti, Chieti, Italy.
| | - Bianca Raffaelli
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
| | | | | | - Daniel Gams Massi
- Neurology Unit, Douala General Hospital, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Najib Kisani
- Department of Neurology, Mohammed VI University Hospital, Marrakech, Morocco
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003, Valladolid, Spain
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Zhang P, Li H, Wang J, Zhang F, Xiao L, Fang Y, Yan D, Xu G, Liu C, Huang Z, Gu M, Zhang H, Sun W. Sex differences in outcomes after endovascular treatment of patients with vertebrobasilar artery occlusion. Eur Stroke J 2023; 8:566-574. [PMID: 37231678 PMCID: PMC10334174 DOI: 10.1177/23969873221151142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Current studies on the role of sex in the prognosis of acute vertebrobasilar artery occlusion (VBAO) are limited. We aimed to explore whether there are sex differences on outcomes in patients treated with endovascular therapy (EVT) for VBAO. METHODS Patients from December 2015 to December 2018 with acute VBAO within 24 h of the estimated occlusion time in 21 stroke centers in China were retrospectively analyzed. Baseline data between sexes were compared in the total population cohort and propensity score (PS)-matched cohort. Multivariate logistic regression and ordinal regression were used to analyze the association of sex with outcomes. Mixed-effects regression model was performed for changes in modified Rankin Scale (mRS) scores in men and women from 90 days to 1 year after discharge. RESULTS A total of 577 patients (28.4% women) were finally included. Multivariate logistic regression showed that women had a lower probability of favorable outcome (mRS score 0-3 at 90 days; OR 0.544; 95% CI 0.329-0.899) and functional independence (mRS score 0-2 at 90 days; OR 0.391; 95% CI 0.228-0.670) as well as a higher possibility of shifting to worse mRS (OR 1.484; 95% CI 1.020-2.158) than men. After PS matching, 391 patients (39.4% women) were analyzed, confirming the same results regarding favorable outcome (OR 0.580; 95% CI 0.344-0.977), functional independence (OR 0.394; 95% CI 0.218-0.712), and shift mRS (OR 1.504; 95% CI 1.023-2.210). However, the results of repeated ANOVA showed that men and women had a comparable functional recovery from 90 days to 1 year. CONCLUSIONS Stroke due to VBAO treated with EVT is associated with worse outcomes in women than in men. However, men and women showed similar long-term improvement trends.
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Affiliation(s)
- Pan Zhang
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Hao Li
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jinjing Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Feng Zhang
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Lulu Xiao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Yirong Fang
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Dingyi Yan
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Guoqiang Xu
- Department of Neurology, The First People’s Hospital of Yongkang, Yongkang, Zhejiang, China
| | - Chaolai Liu
- Department of Neurology, The First People’s Hospital of Jining, Jining, Shandong, China
| | - Zhixin Huang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Mengmeng Gu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hanhong Zhang
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wen Sun
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Cha E, Vyas V, King KD, Reifferscheid L, MacDonald SE. Inclusion of intersectionality in studies of immunization uptake in Canada: A scoping review. Vaccine 2023:S0264-410X(23)00510-8. [PMID: 37202274 DOI: 10.1016/j.vaccine.2023.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Intersectionality refers to the interconnectedness of various social locations creating unique experiences for individuals and groups, in the context of systems of privilege and oppression. As part of immunization coverage research, intersectionality allows healthcare professionals and policymakers to become aware of the constellation of characteristics contributing to low vaccine uptake. The objective of this study was to examine the application of intersectionality theory or concepts, and the appropriate use of sex and gender terminology, in Canadian immunization coverage research. MATERIALS AND METHODS The eligibility criteria for this scoping review included English or French language studies on immunization coverage among Canadians of all ages. Six research databases were searched without date restrictions. We searched provincial and federal websites, as well as the Proquest Dissertations and Theses Global database for grey literature. RESULTS Of 4725 studies identified in the search, 78 were included in the review. Of these, 20 studies included intersectionality concepts, specifically intersections of individual-level characteristics influencing vaccine uptake. However, no studies explicitly used an intersectionality framework to guide their research. Of the 19 studies that mentioned "gender", 18 had misused this term, conflating it with "sex". CONCLUSIONS Based on our findings, there is an evident lack of intersectionality framework utilization in immunization coverage research in Canada, as well as misuse of the terms "gender" and "sex". Rather than only focusing on discrete characteristics, research should explore the interaction between numerous characteristics to better understand the barriers to immunization uptake in Canada.
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Affiliation(s)
- Eunah Cha
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Vidhi Vyas
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Keith D King
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Laura Reifferscheid
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Shannon E MacDonald
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
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Bryski MG, Azad CL, Etchill EW, Rhee DS. Global Disparities in Burn Outcomes: Does Gender Predict Mortality in the Global Burn Registry? J Surg Res 2023; 283:459-468. [PMID: 36434842 DOI: 10.1016/j.jss.2022.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/02/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Global burn injury burden disproportionately impacts low- and middle-income countries. Surgery is a mainstay of burn treatment, yet access to surgical care appears to be inequitably distributed for women. This study sought to identify gender disparities in mortality and access to surgery for burn patients in the World Health Organization Global Burn Registry (GBR). METHODS We queried the World Health Organization GBR for a retrospective cohort (2016-2021). Patients were stratified by sex. Outcomes of interest were in-hospital mortality and surgical treatment. Patient demographics, injury characteristics, outcomes, and health facility resources were compared between sexes with Wilcoxon rank sum test for nonparametric medians, and chi-squared or Fisher's exact test for nonparametric proportions. Multivariable logistic regressions were performed to assess the relationships between sex and mortality, and sex and surgery. RESULTS Of 8445 patients in the GBR from 20 countries (10 low resource), 40% of patients were female, with 51% of all patients receiving surgical treatment during their hospitalization. Female patients had a higher incidence of mortality (24% versus 15%, P < 0.001) and a higher median total body surface area (20% versus 15%, P < 0.001), yet a lower incidence of surgery (47% versus 53%, P < 0.001) following burn injury when compared to males. In multivariable analysis, female sex was independently associated with mortality after controlling for age, time to presentation, smoke injury, percent total body surface area, surgery, and country income status. Female sex was independently associated with surgical care (odds ratio 0.86, P = 0.001). CONCLUSIONS Female burn patients suffer higher mortality compared to males and are less likely to receive surgery. Further study into this gender disparity in burns is warranted.
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Affiliation(s)
| | - Chao Long Azad
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric W Etchill
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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6
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Sun D, Raynald, Huo X, Jia B, Tong X, Ma G, Wang A, Ma N, Gao F, Mo D, Nguyen TN, Miao Z. Sex-Related Differences in Outcomes of Endovascular Treatment for Anterior Circulation Large Vessel Occlusion. Stroke 2023; 54:327-336. [PMID: 36689588 DOI: 10.1161/strokeaha.122.041195] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/15/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Sex disparities in acute large vessel occlusion (LVO) following endovascular treatment (EVT) have been recently reported. However, there is uncertainty about the effect of sex differences on functional outcomes after EVT, particularly in an Asian population. The present study aimed to compare the clinical and safety outcomes between men and women with anterior circulation LVO treated with EVT. METHODS We analyzed data from the ANGEL-ACT (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke: a Prospective Multicenter Registry Study) Registry, which was conducted at 111 hospitals from 26 provinces in China between November 2017 and March 2019. Men and women with anterior circulation LVO treated with EVT were matched using propensity scores. After a 1:1 propensity score matching, we compared the clinical outcomes including 90-day ordinal modified Rankin Scale distribution (primary outcome), procedure duration, successful reperfusion, symptomatic intracranial hemorrhage, and mortality. Furthermore, we explored sex modification on the primary outcome in subgroup analysis. RESULTS Of 1321 patients, 483 (36.6%) were women and 838 (63.4%) were men. The mean age for women and men were 68 and 62 years old, respectively. Among 578 patients identified after matching, there were no sex differences (men versus women) in 90-day ordinal modified Rankin Scale distribution (median [interquartile range], 4 [1-5] versus 3 [1-5], P=0.464), successful reperfusion (86.5% versus 91.0%, P=0.089), symptomatic intracranial hemorrhage (6.5% versus 7.9%, P=0.512), and mortality within 90 days (17.7% versus 17.0%, P=0.826). However, men had a longer median procedure duration than women (86 [52-128] versus 72 [48-110] minutes, β=14.51, [95% CI, 4.19-24.84]; P=0.006). Subgroup analysis showed that in patients with National Institutes of Health Stroke Scale score <15, women tended to have a better outcome than men, whereas there was no gender effect in those with National Institutes of Health Stroke Scale score ≥15 (P for interaction=0.032). CONCLUSIONS Overall, this matched-control study from the ANGEL-ACT study showed similar clinical outcomes between men and women with anterior circulation LVO treated with EVT. However, in the subgroup of patients presenting with lower stroke severity (ie, National Institutes of Health Stroke Scale score <15), women tended to have a better outcome than men highlighting a potential sex disparity for further investigation. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03370939.
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Affiliation(s)
- Dapeng Sun
- Department of Interventional Neuroradiology (D.S., R., X.H., B.J., X.T., N.M., F.G., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Raynald
- Department of Interventional Neuroradiology (D.S., R., X.H., B.J., X.T., N.M., F.G., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Fengtai You anmen Hospital, China (R.)
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology (D.S., R., X.H., B.J., X.T., N.M., F.G., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baixue Jia
- Department of Interventional Neuroradiology (D.S., R., X.H., B.J., X.T., N.M., F.G., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Department of Interventional Neuroradiology (D.S., R., X.H., B.J., X.T., N.M., F.G., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gaoting Ma
- Department of Neurology, Beijing Xuanwu Hospital (G.M.), Capital Medical University, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases (A.X.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology (D.S., R., X.H., B.J., X.T., N.M., F.G., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology (D.S., R., X.H., B.J., X.T., N.M., F.G., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology (D.S., R., X.H., B.J., X.T., N.M., F.G., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston Medical Center, MA (T.N.N.)
| | - Zhongrong Miao
- Department of Interventional Neuroradiology (D.S., R., X.H., B.J., X.T., N.M., F.G., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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He X, Wang X, Zhang M, Zhu W, Liu Y, Sun Q, Chen G, Li M, Ding H. Gender specific cut-off points of age for disability among rural elderly in Anhui Province, China. Front Public Health 2022; 10:945849. [PMID: 36268001 PMCID: PMC9577323 DOI: 10.3389/fpubh.2022.945849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023] Open
Abstract
Objective The purpose of this study was to determine the optimal cut-off values of age for disability in order to predict the risk of disability for older adults in rural areas. Methods WHO Disability Assessment Schedule 2.0 was used to assess disability. The cut-off values of age for disability were obtained by ROC curve analysis. Results The cut-off points of age for cognition restriction, mobility restriction, self-care restriction, getting along with people restriction, life activities restriction, and social participation restriction for men were 70.5, 68.5, 72.5, 70.5, 71.5, and 68.5 years old, respectively. The cut-off points of age for cognition disability, mobility restriction, self-care disability, getting along with people disability, life activities disability, and social participation disability for women were 72.5, 71.5, 70.5, 70.5, 71.5, and 71.5 years old, respectively. Over the cut-off values of age was an independent risk factor for disability (P < 0.05). Conclusion Presenting first disability symptoms were different between men and women. Preventive efforts to prevent future disability should be different for men and women.
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Affiliation(s)
- Xinran He
- School of Health Management, Anhui Medical University, Hefei, China
| | - Xianwen Wang
- School of Public Health and Health Management, Anhui Medical College, Hefei, China
| | - Min Zhang
- School of Health Management, Anhui Medical University, Hefei, China
| | - Weizheng Zhu
- School of Health Management, Anhui Medical University, Hefei, China
| | - Yuyang Liu
- School of Health Management, Anhui Medical University, Hefei, China
| | - Qian Sun
- School of Health Management, Anhui Medical University, Hefei, China
| | - Guimei Chen
- School of Health Management, Anhui Medical University, Hefei, China
| | - Min Li
- School of Health Management, Anhui Medical University, Hefei, China
| | - Hong Ding
- School of Health Management, Anhui Medical University, Hefei, China,*Correspondence: Hong Ding
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Ospel JM, Schaafsma JD, Leslie-Mazwi TM, Amin-Hanjani S, Asdaghi N, Gordon-Perue GL, Couillard P, Hadidi NN, Bushnell C, McCullough LD, Goyal M. Toward a Better Understanding of Sex- and Gender-Related Differences in Endovascular Stroke Treatment: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2022; 53:e396-e406. [PMID: 35695016 DOI: 10.1161/str.0000000000000411] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are many unknowns when it comes to the role of sex in the pathophysiology and management of acute ischemic stroke. This is particularly true for endovascular treatment (EVT). It has only recently been established as standard of care; therefore, data are even more scarce and conflicting compared with other areas of acute stroke. Assessing the role of sex and gender as isolated variables is challenging because they are closely intertwined with each other, as well as with patients' cultural, ethnic, and social backgrounds. Nevertheless, a better understanding of sex- and gender-related differences in EVT is important to develop strategies that can ultimately improve individualized outcome for both men and women. Disregarding patient sex and gender and pursuing a one-size-fits-all strategy may lead to suboptimal or even harmful treatment practices. This scientific statement is meant to outline knowledge gaps and unmet needs for future research on the role of sex and gender in EVT for acute ischemic stroke. It also provides a pragmatic road map for researchers who aim to investigate sex- and gender-related differences in EVT and for clinicians who wish to improve clinical care of their patients undergoing EVT by accounting for sex- and gender-specific factors. Although most EVT studies, including those that form the basis of this scientific statement, report patient sex rather than gender, open questions on gender-specific EVT differences are also discussed.
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Cao M, Li B, Rong J, Li Q, Sun C. Sex differences in global disability-adjusted life years due to ischemic stroke: findings from global burden of diseases study 2019. Sci Rep 2022; 12:6235. [PMID: 35422061 PMCID: PMC9010406 DOI: 10.1038/s41598-022-10198-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/01/2022] [Indexed: 12/28/2022] Open
Abstract
To investigate the sex differences in disability-adjusted life years (DALYs) due to ischemic stroke (IS) by year, location and age. We extracted sex-specific data on DALYs number, age-standardized DALYs rate (ASDR) and all-age DALYs rate of IS by year, location and age from the Global Burden of Diseases study 2019. The estimated annual percentage changes (EAPC) were calculated to evaluate the temporal trend of ASDR. For both sexes, although the ASDR of IS slightly decreased from 1990 to 2019, there has been an 60.3% increase in DALYs number worldwide. Sex difference in DALYs number (men minus women) decreased from − 2.83 million in 1990 to 0.14 million in 2019, while the men to women’s ASDR ratio slightly increased from 1.10 in 1990 to 1.21 in 2019. The sex differences in IS DALYs showed remarkable regional variation. The largest sex differences in DALYs number and ASDR were in China and Vietnam. Middle-aged men had a higher IS DALYs than their age-matched counterparts. High systolic blood pressure accounted for the highest DALYs number in 2019, but the top three attributable risk factors that had the greatest sex differences were tobacco, dietary risk, and alcohol use. Sex differences in IS DALYs varied by year, location and age, mostly attributed to the disproportion of cardiovascular risk factors between sexes. Considering the population growth and aging, it is necessary to monitor the sex difference in IS DALYs in different populations and thus provide evidence for local administration to improve current preventive and management strategies of IS.
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Affiliation(s)
- Miaomiao Cao
- Department of Cardiology, Institute of Cardiovascular Channelopathy, Key Laboratory of Molecular Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Bolin Li
- Department of Cardiology, Institute of Cardiovascular Channelopathy, Key Laboratory of Molecular Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Jie Rong
- Department of Encephalopathy, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Qian Li
- Department of Cardiology, Institute of Cardiovascular Channelopathy, Key Laboratory of Molecular Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Chaofeng Sun
- Department of Cardiology, Institute of Cardiovascular Channelopathy, Key Laboratory of Molecular Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China.
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Uslu N, Erenoğlu R. Does the gender course have any effects on young people's gender equality perceptions, dating violence, and problem-solving behaviours in romantic relationships?: A mixed-method study. Perspect Psychiatr Care 2022; 58:471-481. [PMID: 34114229 DOI: 10.1111/ppc.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 03/31/2021] [Accepted: 05/30/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aims to evaluate the effects of the gender course (GC) on nursing students' gender equality perceptions, dating violence attitudes, and problem-solving behaviors in romantic relationships. DESIGN AND METHODS Using a sequential explanatory mixed-methods design, this study utilized Sociodemographic Form, Gender Equality Scale (GES), Dating Violence Attitudes Scale (DVAS), Problem-solving in Romantic Relationships Scale (PSRRS), and students' written accounts to collect data. FINDINGS GES and PSRRS scores demonstrated no differences between the experimental and control groups; DVAS scores indicated differences. The quantitative findings were supported through the qualitative findings. The GC increased students' awareness about gender equality and dating violence and had positive effects problem-solving skills in romantic relationships. PRACTICE IMPLICATIONS GC could be utilized to raise awareness about gender-based violence.
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Affiliation(s)
- Nevin Uslu
- Department of Pediatric Nursing, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Rabiye Erenoğlu
- Department of Obstetrics and Gynecology Nursing, Hatay Mustafa Kemal University, Hatay, Turkey
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11
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Cislaghi B, Weber AM, Shakya HB, Abdalla S, Bhatia A, Domingue BW, Mejía-Guevara I, Stark L, Seff I, Richter LM, Baptista Menezes AM, Victora CG, Darmstadt GL. Innovative methods to analyse the impact of gender norms on adolescent health using global health survey data. Soc Sci Med 2021; 293:114652. [PMID: 34915243 PMCID: PMC8819155 DOI: 10.1016/j.socscimed.2021.114652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 12/05/2022]
Abstract
Background Understanding how gender norms affect health is an important entry point into designing programs and policies to change norms and improve gender equality and health. However, it is rare for global health datasets to include questions on gender norms, especially questions that go beyond measuring gender-related attitudes, thus limiting gender analysis. Methods We developed five case studies using health survey data from six countries to demonstrate approaches to defining and operationalising proxy measures and analytic approaches to investigating how gender norms can affect health. Key findings, strengths and limitations of our norms proxies and methodological choices are summarised. Findings Case studies revealed links between gender norms and multiple adolescent health outcomes. Proxys for norms were derived from data on attitudes, beliefs, and behaviours, as well as differences between attitudes and behaviours. Data were cross-sectional, longitudinal, census- and social network-based. Analytic methods were diverse. We found that gender norms affect: 1) Intimate partner violence in Nigeria; 2) Unhealthy weight control behaviours in Brazil and South Africa; 3) HIV status in Zambia; 4) Health and social mobility in the US; and 5) Childbirth in Honduras. Interpretation Researchers can use existing global health survey data to examine pathways through which gender norms affect health by generating proxies for gender norms. While direct measures of gender norms can greatly improve the understanding of how gender affects health, proxy measures for norms can be designed for the specific health-related outcome and normative context, for instance by either aggregating behaviours or attitudes or quantifying the difference (dissonance) between them. These norm proxies enable evaluations of the influence of gender norms on health and insights into possible reference groups and sanctions for non-compliers, thus informing programmes and policies to shape norms and improve health. This article presents effective methods to study gender norms in existing global health survey data. We devised conceptual pathways linking gender norms to gender-based health disparities. We identified gender norms proxies and reference groups enforcing the norm. We tested hypotheses linking gender norms to health. These methods can aid policy and programme design to advance gender equality and health.
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Affiliation(s)
- Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | - Ann M Weber
- School of Public Health, University of Nevada, Reno, NV, USA
| | - Holly B Shakya
- Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA, USA
| | - Safa Abdalla
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Amiya Bhatia
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | | | - Iván Mejía-Guevara
- Center for Population Health Sciences, Stanford University School of Medicine, Stanford, CA, USA; Stanford Aging and Ethnogeriatrics (SAGE) Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Lindsay Stark
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ilana Seff
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda M Richter
- Centre of Excellence in Human Development, University of Witwatersrand, Durban, South Africa
| | - Ana Maria Baptista Menezes
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil
| | - Gary L Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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12
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Weber AM, Gupta R, Abdalla S, Cislaghi B, Meausoone V, Darmstadt GL. Gender-related data missingness, imbalance and bias in global health surveys. BMJ Glob Health 2021; 6:e007405. [PMID: 34836912 PMCID: PMC8628344 DOI: 10.1136/bmjgh-2021-007405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/01/2021] [Indexed: 11/04/2022] Open
Abstract
Global surveys have built-in gender-related biases associated with data missingness across the gender dimensions of people's lives, imbalanced or incomplete representation of population groups, and biased ways in which gender information is elicited and used. While increasing focus is being placed on the integration of sex-disaggregated statistics into national programmes and on understanding effects of gender-based disparities on the health of all people, the data necessary for elucidating underlying causes of gender disparities and designing effective intervention programmes continue to be lacking. Approaches exist, however, that can reasonably address some shortcomings, such as separating questions of gender identification from biological sex. Qualitative research can elucidate ways to rephrase questions and translate gendered terms to avoid perpetuating historical gender biases and prompting biased responses. Non-health disciplines may offer lessons in collecting gender-related data. Ultimately, multidisciplinary global collaborations are needed to advance this evolving field and to set standards for how we measure gender in all its forms.
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Affiliation(s)
- Ann M Weber
- School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | - Ribhav Gupta
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Safa Abdalla
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Valerie Meausoone
- Stanford Research Computing Center, Stanford University, Stanford, California, USA
| | - Gary L Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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13
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Crespí-Lloréns N, Hernández-Aguado I, Chilet-Rosell E. Have Policies Tackled Gender Inequalities in Health? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010327. [PMID: 33466282 PMCID: PMC7796005 DOI: 10.3390/ijerph18010327] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 01/20/2023]
Abstract
Gender is recognized as one of the most relevant determinants of health inequalities. This scoping review sought to identify and analyse policies, either implemented or formulated as proposals, which aimed to reduce gender inequalities in health. We searched Medline, Web of Science, and Scielo. Of 2895 records, 91 full text articles were analysed, and 33 papers were included. Of these papers, 22 described the process of formulation, implementation, or evaluation of policies whose aim was to reduce gender inequalities in health; six focused on recommendations, and the remaining five dealt with both issues. Our review showed that the policies aimed at reducing gender inequalities in health, either implemented or formulated as proposals, are scarce. Moreover, despite some success, overall progress has been slow. The studies show failures in design and particularly in the implementation process. We found a lack of awareness and capacity in the policy-making progress, under-financing, bureaucratization, shortage of relevant data, and absence of women’s participation in decision-making. Therefore, an emphasis on the design and implementation of gender-sensitive policies seems essential to advance gender equality in health. This scoping review gathers evidence to support the design of such policies and recommendations that can facilitate their implementation.
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Affiliation(s)
- Nuria Crespí-Lloréns
- Preventive Medicine Service, Hospital General de Elche, 03203 Elche, Spain
- Correspondence:
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández de Elche, 03550 Alicante, Spain; (I.H.-A.); (E.C.-R.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, Universidad Miguel Hernández de Elche, 03550 Alicante, Spain; (I.H.-A.); (E.C.-R.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Kennedy E, Binder G, Humphries-Waa K, Tidhar T, Cini K, Comrie-Thomson L, Vaughan C, Francis K, Scott N, Wulan N, Patton G, Azzopardi P. Gender inequalities in health and wellbeing across the first two decades of life: an analysis of 40 low-income and middle-income countries in the Asia-Pacific region. LANCET GLOBAL HEALTH 2020; 8:e1473-e1488. [PMID: 33091371 DOI: 10.1016/s2214-109x(20)30354-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND By adulthood, gender inequalities in health and wellbeing are apparent. Yet, the timing and nature of gender inequalities during childhood and adolescence are less clear. We describe the emergence of gender inequalities in health and wellbeing across the first two decades of life. METHODS We focused on the 40 low-income and middle-income countries in Asia and the Pacific. A measurement framework was developed around four key domains of wellbeing across the first two decades: health, education and transition to employment, protection, and a safe environment. Specific measurement constructs were then defined by considering gender indicator frameworks, the Sustainable Development Goals, indicator frameworks for child and adolescent health and wellbeing, and key stakeholder input. Available data were then mapped to define 87 indicators, subsequently populated using databases (UN agencies and the Global Burden of Diseases, Injuries, and Risk Factors Study) and nationally representative surveys. Where possible, estimates in girls were compared with boys to report relative risks. FINDINGS Although son preference is evident in some settings-as shown by higher than expected male-to-female sex ratios at birth in India, Vietnam, and China (all >1·10 compared with an expected ratio of 1·05) and excess mortality of girl children in some South Asian and Pacific nations-it is during early adolescence where marked gender inequalities consistently emerged. Adolescent girls face considerable disadvantage in relation to sexual and reproductive health (notably in South Asia and the Pacific), with high rates of child marriage (≥30% of women aged 20-24 years married before 18 years in Bangladesh, Nepal, and Afghanistan), fertility (≥65 livebirths per 1000 girls in Nauru, Laos, Afghanistan, Nepal, Marshall Islands, Bangladesh, Vanuatu, and Papua New Guinea), and intimate partner violence (>20% in Timor Leste, Afghanistan, Pakistan, and Myanmar). Despite educational parity in many countries, females aged 15-24 years were less likely than males to be in education, employment, or training in 17 of 19 countries for which data were available. Compared with girls, adolescent boys experienced excess all-cause mortality and substantially higher mortality due to unintentional injury, interpersonal violence, alcohol and other drugs, and suicide, and higher prevalence of harmful drinking and tobacco smoking. INTERPRETATION These findings call for a focus on gender policy and programming in later childhood and early adolescence before gender inequalities become embedded. FUNDING UNICEF.
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Affiliation(s)
- Elissa Kennedy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Gerda Binder
- East Asia and Pacific Regional Office, UNICEF, Bangkok, Thailand
| | | | - Tom Tidhar
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Karly Cini
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Liz Comrie-Thomson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Cathy Vaughan
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kate Francis
- Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nick Scott
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Nisaa Wulan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - George Patton
- Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter Azzopardi
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia; Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute and School of Medicine, University of Adelaide, Adelaide, SA, Australia.
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